13:30
15:00
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Debate on Pediatric VUR and UPJO
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Stephen S. YangTaiwan
Speaker
UTI & Hydronephrosis: What's New and Asian Guideline UpdateHydronephrosis is a common urological condition in both adults and children. It is frequently associated with urinary tract infection (UTI). However, not all hydronephrosis means upper urinary tract obstruction (UUTO). So, differentiating hydronephrosis into pathological or physiological is important. In pathological hydronephrosis or UUTO, risk factors of UTI should be identified. While in physiological UTI, no further study is required.
In this lecture, classification of upper urinary tract dilatation will be introduced, including SFU and UTD system. Other than intra-venous pyelourography, diuretic renal scan can be useful in differentiating hydronephrosis into physiological or pathological hydronephrosis. Pitfalls in interpreting diuretic renogram will be discussed. A brief review of risk factors of UTI will be done. Finally, Asian guideline on UTI will be updated.
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Yu-Chen ChenTaiwan
Moderator
What We Should Know about Sexual Development Disorders Disorders of Sexual Development (DSDs) represent a spectrum of congenital conditions involving atypical development of chromosomal, gonadal, or anatomical sex. Early identification and accurate diagnosis are essential for guiding clinical management and psychosocial support. This talk will provide an overview of the classification of DSDs, including 46,XX DSD, 46,XY DSD, and sex chromosome DSDs, and highlight key diagnostic steps such as hormonal profiling, genetic testing, and imaging studies. Common conditions such as congenital adrenal hyperplasia (CAH), androgen insensitivity syndrome (AIS), and gonadal dysgenesis will be discussed, with emphasis on a multidisciplinary approach involving pediatric endocrinologists, geneticists, surgeons, and psychologists. Practical considerations in gender assignment, surgical timing, and long-term follow-up will also be addressed. This session aims to equip urology residents with the essential knowledge to recognize and contribute to the care of patients with DSDs.
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Shin-Mei WongTaiwan
Speaker
Opposition to VUR SurgeryVesicoureteral reflux (VUR) is closely associated with urinary tract infections (UTIs) and renal scarring in neonates and children. Primary VUR attributes its pathogenesis to a congenitally short submucosal ureteral tunnel, resulting in inadequate ureterovesical junction resistance. This concept has informed the development of various surgical techniques aimed at increasing ureteral resistance. However, emerging evidence suggests that surgical correction does not consistently offer superior long-term renal outcomes compared to continuous antibiotic prophylaxis (CAP). This raises important concerns regarding the role of surgery as the treatment for high-grade VUR. Given the heterogeneity of VUR, underlying factors such as elevated detrusor pressure, increased urethral resistance, or persistently low ureteral resistance must be thoroughly evaluated and addressed prior to surgical intervention. As VUR remains one of the most debated conditions in pediatric urology, further studies are essential to improve risk stratification and refine treatment algorithms to optimize both infection control and renal preservation.
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Yu-Hua FanTaiwan
Moderator
Updates on Vesicoureteral RefluxVesicoureteral reflux (VUR) remains a critical topic in pediatric urology, with ongoing debates surrounding its diagnosis, management, and long-term outcomes. This presentation will provide an updated overview of the current understanding of VUR, including recent advances in imaging techniques, risk stratification, and non-surgical versus surgical treatment options. Emerging evidence on the natural history of VUR, the role of continuous antibiotic prophylaxis, and evolving criteria for surgical intervention will be discussed. The session will also highlight recent guideline updates, innovations in endoscopic injection materials, and strategies for individualized patient care. By integrating recent clinical data and expert consensus, this talk aims to provide practical insights into optimizing VUR management in contemporary practice.
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Shang-Jen ChangTaiwan
Speaker
Which Surgical Treatment is Best for UPJO in Infants: Open, Laparoscopic, Robotic AssistedAbstract
Ureteropelvic junction obstruction (UPJO) in infants is a condition that can significantly impair renal function and requires timely surgical intervention when certain criteria are met, such as decreased split renal function, poor drainage on diuretic renography, or recurrent urinary tract infections. The three main surgical approaches for treating UPJO are open pyeloplasty (OP), laparoscopic pyeloplasty (LP), and robot-assisted laparoscopic pyeloplasty (RALP). Each technique has its own benefits and limitations, especially when applied to infants.
Minimally invasive surgery (MIS), including LP and RALP, has gained popularity in pediatric urology due to advantages such as shorter hospital stays, reduced postoperative pain, faster recovery, and better cosmetic outcomes. However, the small working space in infants, the steep learning curve, and higher costs are significant limitations. In particular, the utility of MIS in infants remains controversial due to undefined benefits and technical challenges, including limited space for trocar placement and difficulty in intracorporeal suturing.
Current guidelines from the European Association of Urology (EAU) indicate that while RALP is considered the gold standard for older pediatric patients, its role in infants remains less defined due to anatomical and logistical constraints. Open surgery continues to be the mainstay for infantile UPJO due to its well-established success rate and lower cost.
Several studies have addressed the learning curve associated with these techniques. Laparoscopic pyeloplasty requires about 30 cases for a surgeon to achieve proficiency, while RALP demands approximately 18–31 cases depending on the metrics used. Simulation-based training, dry labs, and multicenter collaboration are proposed solutions to accelerate skill acquisition and ensure patient safety.
Cost is another critical consideration. Although RALP generally incurs higher upfront costs, especially in low-volume centers, innovations such as magnetic stents have helped offset some of these expenses by eliminating the need for anesthesia during stent removal. Moreover, the availability of pediatric-specific robotic instruments remains limited and necessitates ongoing development to fully support MIS in smaller patients.
In conclusion, while RALP is increasingly recognized as the standard for pediatric UPJO, its application in infants should be considered selectively, depending on surgeon experience, institutional resources, and patient anatomy. Open pyeloplasty remains a safe and effective option, particularly in very young children. Advances in surgical training, cost reduction strategies, and instrument development will be key to expanding the use of minimally invasive techniques in this population.
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Sujit ChowdharyIndia
Speaker
How I do It: Laparoscopic and Robotic Assisted Pyeloplasty aim is to present the technical points with illustrative cases on the learning experience of
over 600 newborn / open / laparoscopic / robotic pyeloplasties for Pelviureteric junction
obstruction along with long term follow up and management approach to complications
over a twenty year follow up .
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TICC - 2F 201AF
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